Thursday, 27 December 2012

Cardiovascular risk in MS

#MSBlog: Does your MS affect your risk of having a cardiovascular event. i.e. myocardial infarction or stroke?

Epub: Sternberg et al. The Prevalence of the Classical and non-Classical Cardiovascular Risk Factors in Multiple Sclerosis Patients. CNS Neurol Disord Drug Targets. 2012 Dec

Background: Inflammation is known to play a role in cererovascular (CV) risk. MS is a neurodegenerative disease that is initially characterized by inflammatory changes in the brain. The investigators' hypothesized that due to chronic inflammation, MSers would present with a higher levels of CV risk factors than non-MSers. 


Methods: They performed a retrospective chart review on 206 MSers and 142 non-MSers suffering from meningiomas and acoustic neuromas, non inflammatory, non autoimmune diseases of the brain. The obtained data included fasting lipid profiles, plasma glucose, systolic and diastolic BP, serum levels of homocysteine and uric acid, data on iron status, smoking habit, and list of medications. In addition, data on indicators of MS disease severity was obtained for MSers. 

Results: MSers had significantly higher total plasma cholesterol, p = 0.01, and plasma high density lipoprotein, P <0.001, but lower plasma glucose, P <0.001, and systolic blood pressure, P = 0.001, than non-MSers. In addition, MSers had lower erythrocyte sedimentation rate and serum vitamin B12, but higher serum folic acid and vitamin D3 than non-MSers. A positive correlation was observed between plasma glucose and the extended disability status scale (EDSS), P = 0.008, and between plasma glucose and the rate of clinical relapse, P = 0.001. 

Conclusion: The MS pathophysiology may be among factors for the lower CV risk factors in MSers. Future studies should examine whether the chronic use of many pharmacological agents influence CV risk factors in MSers.

Cardiovascular risk!

"This study may have had a simple hypothesis, but is has left many unanswered questions and posed some new ones. I suspect the study is too small to draw any serious conclusions. These sorts of studies needs 10,000+ subjects, and exploratory and validation cohorts, to make sure the finding are real."
"Superficially MSers appear to have a better cardiovascular risk profile than non-MSers. Surprising? Not really!"

"In this study MSers had higher vD levels; I suspect this is confounded by vD supplementation. A lot of MSers now take vD supplements."

"I am intrigued by the observation that there was a positive correlation between plasma glucose levels and EDSS and rate of clinical relapse. This may be confounded by exercise or lack of exercise. People who exercise have lower glucose levels than non-exercisers. The more disabled you are the less likely you are to exercise  Another factor may relate to energy fluxes; could this indicate a problem in consuming glucose? Could the mitochondria or energy factories in MSers have a problem using glucose? There is some evidence than MS affects the functioning of mitochondria. This will need more work."

"I am aware that most of you would criticise this study as being underpowered and of no relevance to MS. However, it is exactly these sorts of studies that make scientists to think in different ways. For example, I think we should start investigating MS from a metabolic perspective and think about it in terms of energetics. Who knows where this will take us?"

6 comments:

  1. I would think there is a link between fat metabolism and MS given my horrible cholesterol levels from young age on. Also maybe simvastatin addresses this issue and that's why it is effective in MS?

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  2. Having discovered recently my cholesterol levels are high. I was wondering if other msers might be similar . Interesting. !

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  3. Why isnt it surprising if MSers have lower risk of CV problems?

    Are low glucose levels generally good or bad?

    In my case too blood cholesterol was high. Though it has been checked only once - this was during a series of investigations when MS was first suspected.

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    1. Re: "Why isn't it surprising if MSers have lower risk of CV problems?"

      Previous studies have shown that MS is more common in higher social classes; the higher up you are the lower your CV risk. MSers also change their behaviour when they develop MS and hence improve the CV risk. They also have multiple contacts with the medical community and CV risk factors are picked-up and modified. There is no one reason, but multiple that could explain the observation.

      Too low blood glucose can cause neurological symptoms from hypoglycaemia. It is the high levels, associated with diabetes, that are bad!

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  4. Is there reason to think that the inflammation in the brain in MS also causes inflammation elsewhere in the body?

    FWIW, unlike the previous commenters, my cholesterol has always been normal. I seem to have inherited a tendency toward low cholesterol levels even when eating a bad diet. When they where tested, my CRP was normal and homocysteine was ever so slightly low. This lack of general inflammation has not stopped my MS from relentlessly progressing.

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  5. Is there reason to think that the inflammation in the brain in MS also causes inflammation elsewhere in the body?

    Not really....although people with MS may have a an increased risk of other conditions such as thyroid disease.

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